Speaker 1: It's great to welcome to the program today, Dr. Ashish Jha, who is a physician,
Brown University professor and a world renowned expert on pandemic preparedness and response.
It's so great to have you on.
I have so many questions and we'll just jump right in.
First things first.
Lots of folks who were very confident in following CDC guidelines for 95 percent of this pandemic
were taking a little bit of back at what seemed like a very rapid advancement from the CDC
in terms of mask wearing and what's safe, particularly for vaccinated people.
What what's your general sense of the balance that the CDC struck between what makes sense
medically and also trying to do things to encourage more people to want to get vaccinated?
Speaker 2: Yeah.
So first of all, thanks for having me here.
I'm excited to be on.
And, you know, the CDC has a couple of different jobs, right?
On one hand, they want to explain to people what the science is.
They want to explain to people what the evidence is.
So you have to go read all the scientific papers yourself.
You can if you want, but you don't have to.
The CDC will give you that summary.
And then they also have a job of giving advice to policymakers about how to manage that science.
And what the CDC did was they came out and said, look, the science is pretty clear.
If you've been fully vaccinated, you're good to go.
You do not need to be wearing a mask in most instances.
And you're really you're fine.
The problem is that implementing that policy is hard for governors because they don't know
who's vaccinated and who's not.
And I think there was maybe a little more attention could have been paid to thinking
through, well, how is this going to get implemented?
But the people who defend the CBC's decision basically say mask mandates were kind of on
their way out anyway.
A lot of states had already lifted them.
And so what the CDC was really doing was just explaining to people what they already knew,
which was that all the mask wearing, all the mask mandates, they're kind of on their way
out.
Speaker 1: The one thing that I hear from lots of parents, which they just don't seem
to have an answer for, and I don't either, is the numbers are going down.
We're seeing lower numbers in many states, almost down to statistical baseline of risk
for being out in the world, et cetera.
But nobody under 12 has been vaccinated.
And so how does this all compute and how are we to to think about that part?
Speaker 2: Yeah, it's a really good question.
I have a yes, I have three kids.
Two of them are above the age of 12 or 14 and 16, and one of them is nine, who obviously
has not gotten vaccinated.
So I think about this a lot from my own family.
And here is how I would think about this.
And this is what I've recommended to people.
First, if you want to protect kids under 12, the single best thing you can do is make sure
everybody around them is vaccinated, their parents, their older siblings.
That becomes critical like that sort of creates a ring of protection against those kids.
Second, you want to live in a community with relatively high vaccination rates.
And what that will do is make sure infection numbers are really low.
And then for some high risk things, maybe you want to pay a little extra attention.
So when I think about it, you know, we have not done indoor dining with my nine year old.
We probably could infection numbers where I live a really, really low, but I've done
indoor dining by myself because I'm fully vaccinated.
And so what I have recommended is watch the infection numbers as they get lower and lower.
You can do more and more indoors without masks for kids, but maybe for some indoor things,
it's reasonable to still have the kids mask up.
If you're going to be in a crowded indoor space, let's say you're in a community where
not everybody or not a lot of people are vaccinated.
That's where you want to be careful.
But other than that, right now, I think we're pretty in pretty good shape, even for younger
kids who have not gotten vaccinated.
Speaker 1: Should there be special guidelines for folks who have been vaccinated but have
either some particular medical condition or are immunocompromised or and and if so, for
now, at what point can that be eased off of?
Speaker 2: Yeah, it's a very good question.
You know, so what's interesting about this, and I get asked about this a lot from patients,
and I talk about this a lot with my colleagues.
Immunocompromised is a broad group of people who have some amount of immunodeficiency.
Some of those people, their vaccine works just great.
They're essentially it works as well as it does for anybody else.
Some of those other people, the vaccine barely works at all.
And so, first and foremost, you got to have a talk with your doctor about the kind of
immediate compromise that you have, because it really does vary a lot.
Second, for the people who are unfortunately in that small group for whom the vaccine essentially
doesn't work at all.
There's studies going on of maybe a third or fourth dose of the vaccine could get them
more protection.
But unfortunately, they need to act like they're unvaccinated because they are or their immune
system is acting that way.
And so they need to continue to mask up.
And if you're if you live with someone with one of those more severe forms of immunocompromised,
said, you have to be very careful.
Certainly everybody around them should be fully vaccinated.
One of the reasons why we've got to get to very, very high levels of vaccination is there
a small proportion of people in our country who are vulnerable for whom vaccines won't
work.
We've got to do a better job protecting them.
Speaker 1: When we talk about some of the variants, including the Delta variant, maybe
first to make sure I'm understanding the math correctly.
If we read, for example, that a particular variant is 60 percent more transmissible,
would it be correct to understand that that means that given a particular scenario, call
it eight minutes indoors unvaccinated?
Right.
If normally there would be a one percent transmission risk for it to be 60 percent more transmissible,
does that mean that that becomes a one point six percent transmission risk?
Speaker 2: Yeah, exactly.
Exactly that it's 60 percent relative.
So you don't go from one to 60 one, thank goodness.
Of course.
But right.
If you see we're at 10 percent now you're at 16 percent.
It's that it's at 60 percent relative risk, but may not sound like a lot, but it actually
when you apply it across the whole population, it's massive.
And you can see it in a place like the United Kingdom, which, by the way, has higher vaccination
rates than we do still.
I mean, we're about the same, but they're a little higher.
You know, they have seen because of the Delta variant and the contagiousness, they have
seen a three to four fold increase in total number of infections across the country despite
high vaccinations, because this this virus, this variant is so much more contagious.
Speaker 1: So for the average person who's vaccinated, would learning about the increasing
prevalence of that variant change what one considers to be safe?
Like what?
What I mean is if you're vaccinated and you see the case numbers and you're saying I'm
going to do a trip in two weeks, we now learn about the fact that this variant is out there.
Should the average person change their activity as a result of that?
Speaker 2: If you're fully vaccinated, not if you're fully vaccinated.
The good news is that the vaccines we have hold up very, very well against the Delta
variant.
So if you're let's say you're planning a trip with four of your friends and they're all
fully vaccinated.
Do your trip.
Don't worry about the delta bearing the Delta variant, you know, it poses a marginal problem
for people who are fully vaccinated, not much of one.
You just tend to get a little bit more through infections, but not people don't get sick
because they're fully vaccinated.
Delta variant is a huge problem for people who are not vaccinated.
Those people are at much, much higher risk without, you know, with the delta than without.
But if you're fully vaccinated, I wouldn't worry.
Speaker 1: Can you talk a little bit about, particularly in the last three weeks, the
hypotheses and discussions about the origins of this virus have gone?
I don't want to say that it's gone mainstream, but there's been significantly more discussion,
including in places where we were not originally seeing it.
My understanding of the spectrum of what is possible would be on the one hand, this had
nothing to do with any lab, even as a pit stop all the way to this was designed as a
bioweapon and deliberately released.
I think it's important, no matter what we explore, to not claim something to be likely
until we have reason to believe that it's likely.
But what do you make of the change in that discussion over the last few weeks and sort
of the state of that question?
Speaker 2: Yeah.
So let's talk about the science and where we are first on the science, and then I would
talk about the discussion.
Yeah.
So you actually really laid out the spectrum?
Well, I could have just been a standard animal to human species, jump very calm.
And it's how we get Ebola.
It's how we got Zika.
This is pretty much the most common way that we get novel infections all the way to.
It was a bioweapon designed to cause a global epidemic.
But that so basically the way I look at it, bioweapon, incredibly unlikely.
A bit more likely is it was it was in a lab now could in a naturally occurring virus.
People were studying in the lab and there was an accidental leak that is more likely
or it wasn't deliberately designed as a bioweapon, but they were working on getting a function
and they caused a virus to become more lethal.
And then it leaked, you know, a little bit less likely, but still on the possibility
range, most likely just based on kind of experience, historical, that there was an animal to human
jump, that there's a species of animals, probably bats, maybe there's a different intermediary
and humans got infected.
The reason I say that's most likely because, again, that's how it usually happens.
But here's the bottom line.
I don't know the answer.
And I would argue that probably no one else does either.
I mean, if it was a lab like maybe a small number of people do, but I certainly don't.
No one else in the United States does.
So what do we need to do?
And first of all, why is it important?
It is important.
We want to know where this virus came from.
We want to understand it not just because it helps us manage this one, but prevent future
ones.
But the other part is we have got to stop politicizing this like, my God, at this point,
we have managed to take this thing.
That's a very complicated and important scientific question.
And people are talking about it as though, like, if you're a Democrat, you believe one
thing and a Republican, you believe another.
I just don't know the right answer.
We need to investigate it.
We need to push China to give us more cooperation.
We need to have the U.S. intelligence and other intelligence agencies invested in it.
We really do need to get to the bottom bottom of this.
Again, if I were a betting person, I'd say probably came from an animal.
But we're not we're not making bets here.
We should actually sort it out.
Speaker 1: Is it the is it concerning or is it in any way relevant or something we should
be thinking about that.
It's not clear who the first human to be infected was or is that just not particularly surprising
if indeed the first human or humans were in a country of one point three billion people?
Speaker 2: Yeah, I think it's important to try to figure out how far back does this go.
So there's some recent data now that's coming out that suggests that the first cases in
the United States may have been in late December and then people who were not traveling, that
means that they got it.
They were infected by somebody who had traveled here maybe in early December pushing the timeline
back.
You know, we probably won't find what people talk about is kind of patient zero the first
person infected?
Yeah, I doubt we'll find that we might, but I doubt it.
But understanding when the virus got going, when were the first group of people infected
who were the first group?
Were they people in the lab?
Were the people who shopped at that market?
I think that will be important.
Part of the tracing here.
This has been such a horrible pandemic.
We have got to get to the best of our ability to the origin, not just where it came from,
but who are the first people infected.
Speaker 1: Last thing I wanted to ask about, certainly you, like many of us, have been
seeing that there is a very significant correlation right now between political views and and
vaccination rates, red and blue states, and also within those states, individuals who
identify politically one way versus the other.
Are these rates now or could they be different enough that the future of this virus becomes
essentially a partizan virus where there is one person?
Critical group that is disproportionately dying from this in the United States.
Speaker 2: He has a good question.
So I actually see it a little bit differently.
And let me kind of make the case for why, OK, when I look at the data, I mean, there's
no doubt about it that if you just look red states versus blue states, it looks like blue
states are doing great on vaccinations.
Red states are not.
But there's other things about red states versus blue states.
So, for instance, public health infrastructure or public health infrastructure is much better.
And a lot of these, quote unquote blue states, and that's what's allowing vaccines to get
out to people.
I still find in a lot of, quote unquote, red states.
There are a lot of people who want to be vaccinated, but they're far away from vaccine sites.
It's not easy for them to get time off.
There are enough barriers that still preventing people.
So I hope that the partizan divide gets better.
And part of it is I can look at states like South Dakota, which is a very red state, and
sixty to sixty three percent of adults have gotten vaccinated almost at the same level
as the national number.
And I think I feel like there are plenty of people on both sides of the political aisle
who have gotten vaccinated.
I don't I think if this were to become a partizan virus, I think if it were to become something
that infected one political group more than I think it'd be very bad for our country,
it would really sap our desire to have kind of a unified response.
It would make this just a bad thing.
The virus certainly doesn't care about the politics.
We've got to do everything we can to depoliticize the virus, not look at it as a red versus
blue thing, but as a human versus virus thing.
And everybody get on the team human and figure out how to defeat the virus without without
question.
Speaker 1: Yeah, we've been speaking with Dr. Ashish Jha, who is a physician and Brown
University professor.
So appreciate your time today.
Speaker 2: Hey, it was my pleasure.
Thanks for having me on.